Preparedness for Emergency Events Among Patients with Chronic Diseases in China: A Cross-Sectional Study

doi:10.21203/rs.3.rs-855982/v1

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Preparedness for Emergency Events Among Patients with Chronic Diseases in China: A Cross-Sectional Study

https://doi.org/10.21203/rs.3.rs-855982/v1

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Background

Large-scale emergencies hurt the chronically ill immensely. Improving personal emergency preparedness is an effective means to protect themself. Our objective is to evaluate the emergency preparedness level and its influencing factors among patients with chronic diseases in China.

Methods

A paper-based self-administrated questionnaire collected data. Descriptive statistics and univariate analysis were used to illustrate the chronically ill's general characteristics and preparedness level. Regression models were constructed to identify influencing factors of preparedness.

Results

A total of 771 samples were included. Only 23% of respondents prepared three days of water, three days of food, available flashlights, and available radios. 50% were equipped with three-day prescription drugs. Patients with chronic respiratory diseases or cancer were less prepared (p < 0.01). Patients who were never married or married (compared with widowed, divorced, or separated); had junior high school degrees (compared with a college degree and above); had monthly household incomes of more than 10,000 yuan; suffered from two or above chronic diseases, often and rarely discussed emergencies with families (compared with never); perceived learning emergency-related information as essential; participated in emergency drills; believed their families have prepared; and had high levels of mental health are more likely to have the four preparations. Factors related to higher levels of prescription drug reserve include owning junior high school or high school degrees, having two or above chronic diseases, being sick for five to nine years (compared to less than or equal to one year), being interested in gathering information about the emergency response, and perceived learning emergency-related information is crucial.

Conclusion

Patients with chronic diseases have a low level of emergency preparedness. Public health officials should formulate tailored policies, information, and intervention measures that target chronically ill patients to improve their emergency preparedness, particularly those with low income, low mental health, divorce, widowhood, or separation.

Health Economics & Outcomes Research

Infectious Diseases

Health Policy

emergency preparedness

patients

chronic disease

survey

Chronic disease refers to a condition with a long duration and slow development, including cardiovascular disease (such as heart attacks and strokes), cancer, chronic respiratory disease (such as chronic obstructive pulmonary disease and asthma), and diabetes, which has high morbidity and mortality [1]. According to the Chinese chronic disease status report in 2015, the prevalence rate of common chronic diseases: hypertension, diabetes, chronic obstructive pulmonary disease, and cancer in China is 25%, 9%, 10%, 235 per 100,000, respectively [2]. China's mortality rate of chronic diseases is 533 per 100,000, accounting for 86% of the total deaths. Among them, cardiovascular and cerebrovascular diseases, cancer, and chronic respiratory diseases are the leading causes of death, accounting for 79% of the total deaths [2].

Emergencies refer to natural disasters, accident disasters, public health incidents, and social security incidents that occur suddenly, cause or may cause serious social harm, and require emergency response measures [3]. Patients with chronic diseases are one of the vulnerable groups to deal with emergencies. They have a higher casualty rate in emergencies than the general population, and they experience more significant difficulties in the recovery phase [4]. Sudden events interrupt the typical medication, treatment, and care plans of chronically ill patients, resulting in aggravation of the disease, and the serious ones directly threaten the safety of life [5]. Ohkouchi's research found that the incidence of chronic obstructive pulmonary emphysema aggravated during the earthquake was 2.5 times higher than before [6]. A study by Huang found that five years after the 512 Wenchuan earthquake, hospitalization rates related to ischemic heart disease continued to rise in severe and extremely severe areas, and hospitalization expenses increased [7]. Meanwhile, Leppold found that during a large earthquake, the proportion of diabetic patients with poor blood sugar control increased from 32–41%, of which 66% experienced at least one deterioration of glycosylated haemoglobin after the disaster [8]. During Hurricane Sandy, the treatment of gynaecological cancer patients was significantly delayed, with an average delay of 8 to 22 days in chemotherapy and 14 to 23 days in planned surgery [9]. In addition, after Hurricane Katrina, the one-year survival rate of hepatocellular carcinoma patients in the disaster area was significantly reduced [10].

Emergency preparedness regards the knowledge, capabilities, and actions of individuals, families, communities, and governments to effectively deal with the impact of emergency events, regardless of whether these events have already occurred [11, 12]. Good personal emergency preparedness plays an essential role in mitigating the damage caused by emergencies to patients with chronic diseases. Emergency preparedness for personal refers to having the necessary items to deal with an emergency, including food, drinking water, medicine, and other necessities [13]. However, the status of emergency preparedness of patients with chronic diseases in China is still unclear. This study aims to investigate the level of emergency preparedness of patients with chronic illnesses, clarify their health needs in disaster response, and provide evidence for improving their disaster response-ability and promoting their health outcomes.

Study design, setting, and participants

This is a paper questionnaire survey conducted in a tertiary hospital located in Wuhan of China. The eligible criteria of participants were hospitalized patients over 18 years old, able to read and write the Chinese language, and with at least one of the chronic diseases of heart attacks, stroke, cancers, chronic respiratory disease, and diabetes. Patients who had cognitive or mobility impairments were excluded. The study was reviewed and approved by the Medical Research Ethics Committee of the hospital.

Data collection

According to previous literature [4, 14-16], 924 respondents, including a likely 20% abrasion, were intended to be investigated. Data collection was collected from 11 May, 2021 to 22 June, 2021. The researchers introduced the study objectives and procedures to suitable participants, and if they showed interest, they were invited to participate and were provided a further explanation of the study. Those who consented to participate signed informed consent before data collection.

Study instrument

The questionnaire was based on previous related research [4, 17-19]. It consists of five sections. The first four sections were self-made. The first section contained the sociodemographic variables, including age, gender, education level, marital status, monthly household income, number of people live with, whether they had Coronavirus Disease 2019 (COVID-19), and types of chronic illness. The second section includes 19 test questions to measure responders' emergency knowledge. Each correct answer was given a score of one point. According to the total score, the respondent's emergency knowledge level is divided into the low level (≤ 10 points), medium level (11-14 points), and high level (≥ 15 points). The third section assessed participants' emergency experience, risk awareness, perceived household preparedness, emergency attitude, and the frequency of discussing emergencies with family with a set of questions. The fourth section used five questions to assess participants' preparedness for emergencies (Additional file 1). The fifth section used the Chinese version of the 12-item Short-Form Health Survey (SF-12) to evaluate the physiological and psychological conditions of the responders [20]. The total score of Physical Component Summary (PCS) and Mental Component Summary (MCS) ranged from 0 to 100, with a higher score representing better self-reported physical or mental health. The upper and lower 30% rule divides high, medium, and low groups [21].

Statistical analysis

Data were analysed with IBM SPSS Statistics version 26 (IBM Corp. Armonk, NY, USA). Univariate descriptive analyses such as frequencies, percentages, means, and standard deviation were implemented to describe the sample's characteristics. Chi-square and non-parametric tests (Mann–Whitney U-test and Kruskal–Wallis H-test) were used to assess the crude association between categorical variables and the study outcomes (general preparedness). Finally, ordered multivariable and binary logistic regression were performed to identify the independent variables affecting general emergency preparedness. Each model contained all covariates. The samples that did not use prescription drugs were excluded when establishing a binary logistic regression with reserve prescription drugs for three days or not as the dependent variable. All regression models generated adjusted odds ratios (AORs) and 95% confidence intervals (CIs). A two-tailed p < 0.05 was considered statistically significant.

Characteristics of the study participants

The final sample size constituted 771 valid respondents. 24% suffered from chronic heart disease, 23% had diabetes, 22% had cancer, 18% had a chronic respiratory disease, and 14% had a stroke. 91% of respondents were married, 61% had a high level of emergency knowledge, 68% were interested in gathering information about the emergency response, 82% were willing to discuss emergency information with others, and 92% were perceived as learning emergency-related information is essential. Few responders (8%) participated in emergency drills in the past five years, and less than a quarter (24%) participated in disaster response courses. Only 6% of responders perceived well prepared for emergencies (Table 1).

Table 1

Characteristics of study participants
Variables	Categories	n	% / Mean ± SD
Gender	Male	484	62.8
Gender	Female	287	37.2
Age (years)	18–40	116	15
	41–65	475	61.6
	≥ 66	180	23.3
Marital status	Never married	38	4.9
	Married	702	91.1
	Widowed, divorced, or separated	31	4.0
Number of people live with	Lives alone	44	5.7
	Live only with spouse	314	40.7
	Live with spouse and other family members	365	47.3
	Live with family members other than your spouse	48	6.2
Types of chronic diseases	Chronic heart disease	212	23.7
	Stroke	125	14.0
	Cancer	195	21.8
	Chronic respiratory disease	158	17.7
	Diabetes	205	22.9
Level of education	Primary and below	159	20.6
	Junior high school	241	31.3
	High school‎ or secondary school	184	23.9
	College degree and above	187	24.3
Monthly household income (¥)	0-1999	131	17.0
	2000–4999	222	28.8
	5000–9999	272	35.3
	10000+	146	18.9
Had COVID-19	No	736	95.5
Had COVID-19	Yes	35	4.5
Number of chronic diseases	One	656	85.1
Number of chronic diseases	Two and above	115	14.9
Sick time (years)	≤ 1	281	36.4
	1–5	186	24.1
	5.1–9.9	147	19.1
	≥ 10	157	20.4
The number of experienced emergencies	< 2	469	60.8
The number of experienced emergencies	≥ 2	302	39.2
Health conditions	Mental health	771	58.10 ± 20.49
Health conditions	Physiological health	771	50.75 ± 22.29
Emergency knowledge	≤ 10	54	7.0
	11-14.9	210	27.2
	≥ 15	507	65.8
The frequency of discussing emergencies with family	Often discuss	105	13.6
	Rarely discuss	546	70.8
	Never discuss	120	15.6
Interested in gathering information about emergency response	No	245	31.8
	Yes	526	68.2
Learn emergency-related information is important	No	62	8.0
Learn emergency-related information is important	Yes	709	92
Willing to discuss emergency information with others	No	138	17.9
Willing to discuss emergency information with others	Yes	633	82.1
Emergency can occur in my living environment in the coming year	No	451	58.5
	Yes	320	41.5
Perceived family preparedness for emergency	Well prepared	49	6.4
	Somewhat prepared	516	66.9
	Not prepared at all	206	26.7
Attended disaster response course	No	588	76.3
Attended disaster response course	Yes	183	23.7
Participated in emergency drills	No	711	92.2
Participated in emergency drills	Yes	60	7.8

The Level Of Emergency Preparations

A total of 74% of respondents had a three-day supply of food, and 60% had a working flashlight and batteries. 59% had a three-day supply of water. The proportion of having working radios and batteries is relatively tiny, at 38%. In general, 12% did not have any of the above four preparations, 14% had one of the four preparations, 28% had two of the four preparations, 24% had three of the four preparations, and only 23% of respondents have the four preparations (Table 2). There is no difference between patients with different disease types in having three days of water, three days of food, and flashlights and its matching batteries. However, stroke patients have the highest proportion of available radios (49%), which is statistically different from the proportion of cancer patients who have radios (32%) (p = 0.003). The proportion of having all four preparations of patients with stroke, chronic heart disease, diabetes, chronic respiratory diseases, and cancer were 36%, 30%, 23%, 18%, and 18%. The proportion of patients with chronic respiratory diseases and cancer who have all four preparations are relatively low and are statistically different from the preparation level of stroke patients (p < 0.01) (Table 2).

Table 2

Emergency preparedness of patients with different chronic disease types ^
Categories	Total (N = 771), %	Chronic heart disease (n = 212), %	Stroke (n = 125), %	Cancer (n = 195), %	Chronic respiratory disease (n = 158), %	Diabetes (n = 205), %	P value
Have a three-day supply of water	58.8	66.5	65.6	55.9	57.0	58.0	0.106
Have a three-day supply of food	74.4	78.3	79.2	76.9	65.8	76.6	0.038
Have a working flashlight and matching battery	60.3	63.7	68.0	59.5	56.3	63.4	0.285
Have a working radio and matching battery	37.5	43.9	48.8	32.3 ^a	37.3	34.6	0.013
Have a three-day supply of prescription medication	50.3	74.3	51.9 ^b	56.9 ^c	57.1^d	66.9	< 0.001
Have the zero item of the four preparedness ^†	12.1	11.3	12	8.7	13.9	11.7	0.014
Have the one item of the four preparedness	13.9	10.4	7.2	17.9	14.6	13.2
Have the two items of the four preparedness	27.8	23.1	24	31.3	30.4	28.8
Have the three items of the four preparedness	23.6	25	20.8	24.1	23.4	23.4
Have the four items of the four preparedness	22.7	30.2	36.0	17.9 ^e	17.7 ^f	22.9
^{^} The total number of people suffering from the five diseases exceeds the total number of responders (N = 771), due to 14.9% have more than one sickness.
^† “items of the four preparedness” refers to “a three-day supply of water, a three-day supply of food, a working flashlight and matching battery, and a working radio and matching battery.”
^a P = 0.003, vs. Stroke group; ^b P < 0.001, vs. Chronic heart disease group; ^c P = 0.001, vs. Chronic heart disease group; ^d P = 0.002, vs. Chronic heart disease group; ^e P = 0.001, vs. Stroke group; ^f P = 0.008, vs. Stroke group.

Among the 771 participants, almost half prepared prescription drugs for at least three days (50%), 19% replied that they did not need prescription drugs, and 31% responded they did not prepare for three-day prescription drugs. Heart disease patients had the highest rate of preparing prescription drugs at 74%; followed by diabetes patients (67%); cancer patients at 57%, chronic respiratory disease patients at 57%, and stroke patients with the lowest prescription drug preparation rate at 52% (Table 2). Stroke patients, cancer patients, and patients with chronic respiratory diseases have more inadequate prescription drug preparation than heart disease patients, and the difference is statistically significant (p < 0.01) (Table 2).

Factors Associated With Emergency Preparedness

The probability of possessing the four preparations (food, water, flashlight, and radio) for never married and married is 4.46 (95% CI: 1.68–11.85) and 2.51 (95% CI: 1.10–5.75) times that of divorce, separation, or widowed, respectively. Patients with junior high school degrees are more likely to make the four preparations than patients with college degrees or above (AOR = 1.62, 95% CI: 1.10–2.37). Compared with patients with monthly household incomes are 10,000 or above, the probability of preparing the four items is reduced by 40% and 50% of patients with monthly household incomes between zero to 999 yuan (AOR = 0.58, 95% CI: 0.36–0.92) and between 2000 to 4999 yuan (AOR = 0.64, 95% CI: 0.42–0.95), respectively. Patients with two or more diseases are 2.06 times more likely to be prepared for the four preparations than patients with only one disease (95% CI: 1.40–3.04). Patients who often discuss emergencies with families are 1.96 times (95% CI: 1.13–3.41) and 1.27 times (95% CI: 0.86–1.87) to be prepared for the four preparations than patients who never discuss emergencies with families and rarely discuss emergencies with families, respectively. Compared with patients who have not participated in emergency drills, the probability of being prepared for the four preparations of patients who have participated in emergency drills is 1.89 (95% CI: 1.09–3.30). Compared with patients who believe it is not essential to learn emergency-related information, the probability of having the four preparations of patients who think it is crucial to learn emergency-related information is 3.25 (95% CI: 1.80–5.84). Compared with patients who believe their families are entirely unprepared, patients who think their families are well or somewhat prepared are 3.34 (95% CI: 1.78–6.27) and 2.66 (95% CI: 1.91–3.71) times to equip the four preparations, respectively. Compared with the high mental health group, the proportion of having the four basic preparations of patients in the low mental health group (AOR = 0.62, 95% CI: 0.40–0.97) and the middle group (AOR = 0.56, 95% CI: 0.40–0.80) are reduced by 48% and 44%, respectively (Table 3).

Table 3

Factors associated with the four preparedness items a: results of ordinal logistic regression model
Variables	Zero item %	One item %	Two items %	Three items %	Four items %	AOR (95% CI)	P value
Gender/Sex
Male	12.6	14.0	27.5	22.5	23.3	0.92 (0.70 to 1.21)	0.551
Female	11.1	13.6	28.2	25.4	21.6
Age (years)
18-40.9	12.1	15.5	25.9	22.4	24.1	0.85 (0.51 to 1.43)	0.544
41-65.9	11.6	12.6	29.1	24.8	21.9	0.98 (0.70 to 1.37)	0.896
≥ 66	13.3	16.1	25.6	21.1	23.9
Marital status
Never Married	10.5	10.5	23.7	23.7	31.6	4.46 (1.68 to 11.85)	0.003
Married	11.8	13.8	27.9	23.6	22.8	2.51 (1.10 to 5.75)	0.029
Widowed, divorced, or separated	19.4	19.4	29.0	22.6	9.7
Number of people live with
Lives Alone	13.6	6.8	34.1	22.7	22.7	1.42 (0.66 to 3.05)	0.375
Live Only with Spouse	9.6	15.3	29.3	26.1	19.7	1.05 (0.55 to 2.01)	0.883
Live with spouse and other family members	14.0	13.4	25.5	21.6	25.5	0.923 (0.49 to 1.74)	0.805
Live With Family Members Expect Spouse	12.5	14.6	29.2	22.9	20.8
Level of education
Primary and below	15.1	12.6	31.4	18.9	22.0	1.49 (0.92 to 2.26)	0.115
Junior high school	12.9	14.9	24.9	24.5	22.8	1.62 (1.10 to 2.37)	0.014
High school‎ or secondary school	8.7	13.6	27.2	27.7	22.8	1.46 (0.98 to 2.16)	0.064
College degree and above	11.8	13.9	28.9	22.5	23.0
Monthly household income (¥)
0-1999	14.5	13.0	29.0	24.4	19.1	0.58 (0.36 to 0.92)	0.022
2000–4999	14.4	14.4	26.6	24.8	19.8	0.64 (0.42 to 0.95)	0.029
5000–9999	12.1	14.3	30.1	18.8	24.6	0.74 (0.51 to 1.09)	0.129
10000 +	6.2	13.0	24.0	30.1	26.7
Had COVID-19
No	12.2	13.9	27.7	23.6	22.6	0.61 (0.32 to 1.19)	0.125
Yes	8.6	14.3	28.6	22.9	25.7
Number of chronic diseases
One	12.7	15.1	27.9	23.6	20.7
Two and above	8.7	7.0	27.0	23.5	33.9	2.06 (1.40 to 3.04)	0.000
Sick time (years)
≤ 1	9.6	16.0	26.7	26.0	21.7	1.27 (0.86 to 1.87)	0.222
1–5	13.4	14.0	28.5	21.0	23.1	1.06 (0.71 to 1.60)	0.771
5.1–9.9	12.2	11.6	30.6	21.1	24.5	1.14 (0.75 to 1.75)	0.540
≥ 10	14.6	12.1	26.1	24.8	22.3
The number of experienced emergencies
< 2	12.4	14.1	26.9	22.4	24.3	1.06 (0.81 to 1.39)	0.685
≥ 2	11.6	13.6	29.1	25.5	20.2
Mental health level
≤ 23.44	14.6	14.2	26.4	23.4	21.3	0.62 (0.40 to 0.97)	0.036
23.45–34.37	12.5	14.5	31.3	22.7	19.1	0.56 (0.40 to 0.80)	0.001
≥ 34.38	8.8	12.7	24.6	25.0	28.9
Physiological health level
≤ 18.75	14.2	13.8	25.9	22.2	23.8	1.23 (0.80 to 1.90)	0.348
18.76–31.24	12.1	13.3	28.4	24.2	22.0	1.38 (0.97 to 1.95)	0.074
≥ 31.25	10.1	14.6	28.7	24.3	22.4
Emergency knowledge
≤ 10	33.3	13.0	20.4	13.0	20.4	0.92 (0.52 to 1.63)	0.771
11–14	11.4	14.8	28.6	24.8	20.5	1.17 (0.86 to 1.59)	0.321
≥ 15	10.1	13.6	28.2	24.3	23.9
The frequency of discussing emergencies with family
Often discuss	3.8	11.4	21.0	21.9	41.9	1.96 (1.13 to 3.41)	0.017
Rarely discuss	11.7	12.3	29.5	24.9	21.6	1.27 (0.86 to 1.87)	0.223
Never discuss	20.8	23.3	25.8	19.2	10.8
Interested in gathering information about emergency response
No	23.3	13.1	29.4	20.0	14.3	0.73 (0.53 to 1.02)	0.067
Yes	6.8	14.3	27.0	25.3	26.6
Learn emergency-related information is important
No	41.9	17.7	22.6	11.3	6.5
Yes	9.4	13.5	28.2	24.7	24.1	3.25 (1.80 to 5.84)	0.000
Willing to discuss emergency information with others
No	26.8	15.9	26.8	18.1	12.3	0.91 (0.60 to 1.38)	0.661
Yes	8.8	13.4	28.0	24.8	25.0
An emergency can occur in my living environment in the coming year
No	12.9	13.3	28.4	23.3	22.2	1.16 (0.89 to 1.53)	0.271
Yes	10.9	14.7	26.9	24.1	23.4
Perceived family preparedness for emergency
Well prepared	4.1	6.1	28.6	20.4	40.8	3.34 (1.78 to 6.27)	0.000
Somewhat prepared	8.1	11.4	27.3	25.6	27.5	2.66 (1.91 to 3.71)	0.000
Not prepared at all	23.8	21.8	28.6	19.4	6.3
Attended disaster response course
No	14.1	14.3	28.9	21.6	21.1	0.91 (0.65 to 1.27)	0.569
Yes	5.5	12.6	24.0	30.1	27.9
Participated in emergency drills
No	12.7	14.2	29.0	23.6	20.5
Yes	5.0	10.0	13.3	23.3	48.3	1.89 (1.09 to 3.30)	0.024
^a “the four preparedness items” refers to “a three-day supply of water, a three-day supply of food, a working flashlight and matching battery, and a working radio and matching battery.”

The binary logistic regression results showed that compared with patients whose education levels are primary and below, patients with education levels are junior high school (AOR = 2.52, 95% CI: 1.45–4.41), and high school or secondary school (AOR = 2.14, 95% CI:1.19–3.85) have higher proportions of prescription drug preparation. Patients with two or more diseases are more prepared for prescription drugs (AOR = 1.86, 95% CI: 1.05–3.29). Compared with patients who have been ill for less than or equal to one year, patients who have been sick for five to nine years are more prepared for prescription drugs (AOR = 2.02, 95% CI: 1.18–3.46). Patients interested in gathering information about emergency response have a high preparation of prescription drugs (AOR = 1.85, 95% CI: 1.18–2.92). Patients who believe it is crucial to learn emergency-related information have higher prescription drug preparation rates (AOR = 5.33, 95% CI: 2.07–13.79) (Table 4).

Table 4

Factors associated with having a three-day supply of prescription medication: results of binary logistic regression
Variables	A three-day supply of prescription medication (N = 626), %	AOR (95% CI)	P value
Gender
Male	61.4
Female	62.9	1.43 (0.96 to 2.12)	0.076
Age (years)
18-40.9	63.9
41-65.9	60.1	1.23 (0.68 to 2.23)	0.498
≥ 66	65.6	1.88 (0.91 to 3.88)	0.087
Marital status
Never married	70.0
Married	62.3	0.44 (0.15 to 1.30)	0.136
Widowed, divorced, or separated	44.0	0.27 (0.07 to 1.07)	0.062
Number of people live with
Lives alone	54.8
Live only with spouse	62.0	1.46 (0.50 to 4.28)	0.492
Live with spouse and other family members	63.9	1.34 (0.47 to 3.83)	0.583
Live with family members except for spouse	52.6	0.75 (0.24 to 2.30)	0.614
Level of education
Primary and below	46.0
Junior high school	65.9	2.52 (1.45 to 4.41)	0.001
High school‎ or secondary school	65.4	2.14 (1.19 to 3.85)	0.011
College degree and above	66.5	1.61 (0.85 to 3.04)	0.141
Monthly household income (¥)
0-1999	55.1
2000–4999	55.0	0.10 (0.56 to 1.78)	0.988
5000–9999	64.5	1.43 (0.80 to 2.56)	0.232
10000 +	73.3	1.80 (0.90 to 3.57)	0.095
Had COVID-19
No	61.8
Yes	65.4	1.49 (0.57 to 3.85)	0.415
Number of chronic diseases
One	60.2
Two and above	71.4	1.86 (1.05 to 3.29)	0.034
Sick time (years)
≤ 1	54.7
1–5	63.4	1.51 (0.92 to 2.47)	0.105
5.1–9.9	68.9	2.02 (1.18 to 3.46)	0.011
≥ 10	66.2	1.51 (0.88 to 2.59)	0.137
The number of experienced emergencies (times)
< 2	61.5
≥ 2	62.7	1.22 (0.83 to 1.79)	0.312
Mental health level
≤ 23.44	55.9
23.45–34.37	61.7	0.99 (0.61 to 1.63)	0.976
≥ 34.38	69.1	1.11 (0.60 to 2.07)	0.732
Physiological health level
≤ 18.75	55.1
18.76–31.24	61.2	1.35 (0.81 to 2.26)	0.253
≥ 31.25	69.5	1.69 (0.91 to 3.13)	0.094
Emergency knowledge
≤ 10	30.0
11–14	59.9	2.46 (0.99 to 6.10)	0.052
≥ 15	65.8	2.41 (0.99 to 5.88)	0.053
The frequency of discussing emergencies with family
Often discuss	77.3
Rarely discuss	61.5	0.69 (0.36 to 1.31)	0.252
Never discuss	50.0	0.78 (0.34 to 1.77)	0.549
Interested in gathering information about emergency response
No	44.0
Yes	69.9	1.85 (1.18 to 2.92)	0.008
Learn emergency-related information is important
No	17.4
Yes	65.5	5.33 (2.07 to 13.73)	0.001
Willing to discuss emergency information with others
No	42.3
Yes	66.2	0.91 (0.51 to 1.64)	0.763
An emergency can occur in my living environment in the coming year
No	60.4
Yes	64.0	0.93 (0.63 to 1.36)	0.703
Perceived family preparedness for emergency
Well prepared	78.4
Somewhat prepared	66.4	0.61 (0.24 to 1.55)	0.296
Not prepared at all	46.6	0.44 (0.16 to 1.18)	0.101
Attended disaster response course
No	58.4
Yes	73.2	1.27 (0.79 to 2.06)	0.323
Participated in an emergency drill
No	60.3
Yes	81.6	1.650 (0.70 to 3.89)	0.253

Medically vulnerable people are more brittle in emergencies, and they should be more comprehensively prepared in emergency preparedness than healthy people. However, studies found that people with poor physical health and limited mobility or disabilities are less likely to have a three-day supply of water, a three-day supply of food, a working battery-operated radio, and a working flashlight than healthy people [22, 23]. Therefore, emergency preparedness of medically vulnerable populations may require more attention and different strategies by emergency planners. This study specifically explored the general emergency preparedness levels of the chronically ill at greater risk of harm from emergencies or disasters to promote future preparedness. The association among preparedness and demographic variables, emergency knowledge, state of health, risk awareness, perceived household preparedness, and emergency attitudes were also evaluated.

The occurrence of emergencies urged individuals to prepare emergency items and enhance their awareness of prevention [24]. However, not long after COVID-19, the individuals' emergency preparedness rate is still meagre. Our preliminary results indicate that most responders think it is necessary to understand emergency-related information and are interested in collecting emergency response information, but most of the population is unprepared. In a study of South Korea, the proportion of the four preparations (food, water, flashlight, and radio) was 11% [14], and a study in the United States reported a proportion of 42% [23]. Considerable improvements can be made with emergency preparedness among patients with chronic medical conditions in China. Chinese patients with cancer or chronic respiratory diseases should be paid more attention because of their lower preparedness levels among the investigated conditions.

Although the survey respondents have at least one chronic disease, the three-day prescription drug reserve rate is only over half (50%). But, in a study of medically vulnerable populations in the United States, this proportion exceeds 87% [23]. Moreover, our results showed low prescription drug reserves for patients with cancer, chronic respiratory diseases, low-educated, new patients, and single disease patients. Because almost a quarter of the Chinese live with one or more chronic diseases [25] and are often require access to medications and other treatments, a greater focus on supporting them to reach optimal levels of emergency preparedness is necessary. Chinese doctors can write long-term prescriptions within four weeks to guarantee patients with chronic diseases [26]. We should encourage medical staff to communicate with patients based on their condition to get their drug reserves to ensure they have three days or more of prescription drug reserves to deal with possible emergencies [27].

Consistent with previous studies, this study found that low income is related to insufficient emergency preparedness [13, 18, 22]. Low-income people often cannot bear the materials they need to prepare for any emergency [28], and they are even less capable of coping with the burden of crisis [29]. The effects of gender and age on emergency preparedness have been inconsistent in research. Some studies found that women were less prone to prepare for emergencies than men [18, 22, 30]. But an Israeli study found that females showed significantly higher preparedness levels than male participants [4]. Also, studies found that the older the age, the better the emergency preparedness [13, 18]. The elderly over 65 are more likely to develop an emergency evacuation plan and prepare a three-day supply of prescription drugs [14]. Consistent with the results of Chen et al., this study did not find that the effect of gender and age on emergency preparedness [15]. The previous research found that the higher level of education, the adequate the emergency preparedness [13, 18, 31, 32], but our results showed that respondents with a junior high school degree are more likely to prepare three days of food, three days of water, radio, and flashlight than a college degree and above. The result is consistent with the study regarding emergency preparedness of the elderly, which reported that individuals with a bachelor's degree or higher were less likely to have a seven-day supply of food and water than the individuals reporting some college, respectively [27]. However, academic qualifications are positively correlated with prescription drug reserves. Therefore, it is necessary to understand the differences in emergency preparedness among people with different education levels.

Family structures affect emergency preparedness. Divorced, widowed, or separated patients have low preparedness. The result is consistent with the study of Ekenga et al., which found that divorce, widowed, or separated women are relevant to decline emergency preparedness [18]. Studies found that living alone is related to emergency preparedness [4, 27, 33]. However, this study did not find that living alone impacts emergency preparedness, which may be related to the small number of respondents who chose to live alone in this study. Further research is needed to explore the relationship between living alone and emergency preparedness in the vulnerable Chinese population. However, this study did not find that living alone impacts emergency preparedness, which may be related to the relatively small number of respondents who chose to live alone in this study. Further research is needed to explore the relationship between living alone and emergency preparedness in the vulnerable Chinese population.

This study found that patients suffering from two or more chronic diseases have a higher level of emergency preparedness than patients suffering from one chronic disease. A study with the disaster preparedness of vulnerable older adults with chronic illnesses also found that respondents with two or more chronic conditions were more likely to have a three-day supply of prescription medication (OR = 3.49, 95% CI: 1.22–9.95) than respondents without a chronic disease [14]. Another study found that patients with three or more chronic diseases are less likely to have the four basic preparations [23]. Patients suffering from multiple diseases may have more concerns about their conditions, and their risk awareness may be more robust. It is a choice that is in line with their interests for them to be more prepared.

Knowledge is considered a major influencing factor of preparedness in a study in the Chinese population [15], which is not found in this study. Due to there is no objective scale in the knowledge test, the question types are self-made, and more participants with high scores may cause insufficient discrimination of the question types. Similarly, a previous study showed that participants in disaster preparedness courses are more likely to be prepared [13]. Still, our results showed no relationship between participating in disaster training courses and emergency preparedness. While participating in emergency drills is associated with a higher level of preparedness, which is consistent with the study of Waring et al. [34]. Due to the COVID-19 epidemic, all participants had at least one emergency experience. However, our research found that the number of prior experiences with emergency experiences is not related to preparedness, which is inconsistent with the previous study [13]. It may be related to the unclear definition of emergencies in the research and the different understanding of participants. It is necessary to investigate further the relationship between the number and type of emergency experience and the emergency preparedness of each population.

This study found a negative correlation between low levels of mental health and emergency preparedness. Consistent with the survey of Eisenman et al., which found that chronic medical and psychiatric illnesses were associated with lower rates of personal preparedness, both for supplies and plans [35]. Nevertheless, Faupel and Styles found that the greater the psychological pressure, the higher the level of disaster preparedness. Faupel and Styles found that psychological stress correlated with increased household disaster planning [36].

Many Chinese assume destiny and accept that emergencies or disasters are fated beyond one's control and cannot be changed [37]. This heightened belief in fate would predict lower action and agency [38]. China also emphasizes collectivism. When one party has difficulties, all parties support it. After large-scale emergencies, the Chinese government often responds quickly. Therefore, acknowledging fate and trusting the government in everything leads to a deficiency of preparedness for individuals to respond to emergencies [39]. However, even if the country and the community can respond immediately after large-scale emergencies, the government cannot guarantee the safety of everyone in all situations. Before the arrival of external assistance, the primary emergency preparedness of individuals and families can significantly reduce the negative consequences of an emergency [40].

A study showed that if individuals trust the local government more, they will consider the risk estimates and risk relief policies more credible [39]. Given the faith in the government, their propaganda and policy formulation can increase the individual's perception of prevention. But the information released by the government through official channels is hard for low incomes and education populations to obtain. It is necessary to disseminate official emergency preparedness information through mass media and communities, to help people access, understand, and apply it [13, 17]. Furthermore, the current emergency policies are universal, and no feasible and specific guidelines for vulnerable groups, such as the elderly, the disabled, pregnant women, and children. Therefore, more detailed recommendations are needed for subgroups that are more affected by the emergency.

Emergency preparedness information usually focuses on informing people how to prepare. More importantly, ensuring information to encourage behaviour change, take actual actions to prepare. Regular emergency planning exercises based on realistic scenarios can improve emergency preparedness levels across individuals, teams, agencies, and multi-agency [34]. It is encouraged to extend emergency drill training to communities and establish emergency drill training centres for the public. Based on the assessment of family emergency knowledge, a series of policies and interventions should be adopted to improve residents' risk awareness and willingness to prepare for disasters. Communities play a vital role in emergency management. A study showed that the higher the community disaster management score, the stronger the residents' emergency preparedness, knowledge and skill preparation, and comprehensive preparedness [32]. Communities that are closely connected and caring about each other can better exchange disaster knowledge and improve scientific disaster prevention knowledge [32]. A series of policies and interventions based on communities should be adopted to enhance residents' emergency preparedness.

This study has several limitations. First, the study was conducted in a single centre, provided to a convenience sample. Only hospitalized patients who could complete the questionnaire alone were included, so the results could not be promoted to a broader population. Second, the aspects of preparedness we investigated may be incomplete, not fully reflecting respondents' emergency preparedness status.

In this study, patients who have high incomes, suffer from multiple chronic diseases, participate in emergency drills, think that understanding emergency information is crucial, and have a high level of mental health are at a higher level of preparation. At the same time, divorced, widowed, and divorced are at a lower level of preparedness. To develop interventions further investigation should be conducted to understand the motivations and facilitators for preparation in patients with chronic diseases. In addition, emergency preparedness surveys of other subpopulations (the disabled, the elderly, and rural people) should be carried out to compare the similarities and differences in their preparedness characteristics. We should regard the preparation as a process in which individuals, families, caregivers, and community health and social welfare services are collectively responsible, maintaining the continuity of care for vulnerable groups and reducing the adverse health consequences of future events. Emergency management agencies and public health officials can use research results as a basis for establishing policies and projects that encourage developing personal emergency preparedness plans.

AOR

adjusted odds ratio; CI:confidence interval; COVID-19:Coronavirus Disease 2019

Ethics approval and consent to participate

The study was reviewed and approved by the Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology Review Board (reference TJ-IRB20200375). Each participant signed informed consent before filling out the questionnaire.

Consent for publication

Not applicable.

Availability of data and materials

All data generated or analysed during this study are included in this published article and its supplementary information files.

Competing interests

The authors declare that they have no competing interests.

Funding

The research was supported by "the Fundamental Research Funds for the Central Universities" (No. 2020kfyXGYJ083).

Authors' contributions

HW and YL conceived the idea for the study. MCD and PZ conducted the survey. MCD analysed the data and interpreted the results. MCD, PZ, and XYY wrote the original manuscript. HW and YL reviewed and edited the manuscript. All authors read and approved the final manuscript.

Acknowledgements

We thank Qinghua Liu, Qiu Xiang, Chunyan Xu, Jie Dong, Zongfeng Liao, and Sufen Wang from the Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology for helping with the data collection. We would also like to thank all the patients at the Tongji Hospital for cooperating with the survey.

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Preparedness for Emergency Events Among Patients with Chronic Diseases in China: A Cross-Sectional Study

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